Prodromal and Early Symptoms of Bright's Disease

1891 Boston Medical and Surgical Journal  
as a condition free from danger, but on the whole as a wise provision of Nature ; not as a storm to be controlled by antipyretics, but as a ship to be guided by safe routes, by natural methods, until the storm is past." Holmes believed that it would be (on the whole) better if all drugs were poured into tho sea, than given in the blind, unthinking way they are. To bo sure, ho pitied the fishes. This was an exaggerated statement, but such men as ho and Jackson did much to stay the empirical
more » ... istration of medicine, so prevalent at that time. Hoinaim, as a surgeon, has deserved much from the profession, for his frankness and minuteness of detail in his published cases. Thomas, as a teacher, does not hesitate to admit that many pet theories of his own, have been laid by on the shelf as useless. Mr. Tait, in a recent paper, admits that there are many cases requiring removal of the uterine appendages, for nervous symptoms alone. His former teaching has been contrary to this. I do not quote his exact language, but simply the substance. He is a man of strong conviction, but his immenso experience and broad views have taught him that there is a common-sense association of symptoms and cause ; that errors of diagnosis, in this class of cases, have been made, I have no doubt; but that is no fault of the theory. No man has shown more frankness in acknowledging what he believes to be errors than Mr. Lister. No one has received more criticism, or borne it more cheerfully. The chief point upon which he has been most severely criticised, was that of the use of chemicals in the form of spray into the fresh wounds, with a view to their effect upon the surrounding atmosphere and the noxious germs contained therein. Some of the best men in the profession, throughout the civilized world, honestly and frankly believed aud taught that not only were the germs contained in the atmosphere harmless but that a spray of 1 to 40 of carbolic acid, must of necessity be harmful and poisonous. Instances of poisoning were abundant in the current literature of the day, and the opponents of the system declared honestly that such a plan was contrary to common sense, aud useless. The fact that open wounds of the " face and other parts, difficult to cover aud usually clean, healed so promptly was an argument adduced. Yet the spray was insisted upon as a sine qua non in surgery. Read what Mr. Lister says in his address at the last International Medical Congress at Rerun, last August: " As regards the spray, I feel ashamed that I should have ever recommended it for the purpose of destroying the microbes of the air." He goes still further when he says, " And yet I must confess that 1 have for a long time doubted whether either the washing or the irrigation is really necessary. Those doubts have been raised partly by experiments, some of which I mentioned at the London Congress, which had proved to mo that normal blood and even pus, were by no means favorable soil for the growth of microbes, in the form in which they are prosent in the air." This expression of Mr. Lister is that of an honest man, endowed with common sense, and voiced the sentiment of a largo number of equally honest, commonsense men, who had opposed tho irrigation of fresh wounds by chemicals of a destructive and toxic character. His more modern and simpler asepsis appeals at onco to the common sense of all of us, while antiseptics for septic cavities and surfaces, every one approves and uses. The most wonderful, brilliant meteor that has appeared in the medical sky in our day and generation is certainly the theory advanced by Koch on the cure of tuberculosis. Already its brightness has dimmed; and I believe not many months will elapse ere it will sink in oblivion, and bo remembered only as one of the delusions of medical lore. It did not stand from the first as a common-seiiBe method, but the honesty and scientific ability of its originator gave us muc'n to hope. Having thus briefly touched upon some of the more prominent elements of success in the practice of the profession of medicine, our time will not allow a further discussion as to many other things so essential to the making an ideal physician and surgeon. We must ever remember that there is no royal road to success, in this or any other calling ; that there is no mysterious methods in legitimate study ; but that by long and patient labor in the lines suggested, a young man who seriously begins his course may reach to almost any point in professional eminence that has ever been attained. It is an old and very trite saying, that "Genius is simply an infinite capacity for taking pains," which, translated into the language of our theme, means the application of common sense to our every-day lifework. I cannot better close this paper than by a quotation from an article from the pen of one of London's best writers and investigators, Dr. li. W. Hichai'dson : "Twenty years ago we were steering well and steadily toward great principles on the preventive as well as the curative side of medicine. Then there crept in the wild enthusiasm for bacteriological research,-research good enough in its way, as a piece of natural history, and as disclosing some curious vital phenomena developed under morbid states of the organic structures and the blood, but a positive insanity when accepted as the one absorbing pursuit, restoring the humoral pathology, ignoring nervous function, leading to Babel with its utter confusion of tongues, and separating for a time our modern art of cure from tho accumulating treasures of knowledge, wisdom and light of over two thousand years."
doi:10.1056/nejm189109101251102 fatcat:u6ibaol2c5fjnpxcaprximdjly